Abstract
BACKGROUND: Accidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design. METHODS: The prevalence of 38 risk factors was recorded at a baseline assessment of 1763 subjects (aged 60-93 years). The incidence of one or more falls was recorded after three and six years. The predicted risk of falling, after exposure to the various risk factors, was analysed in a multiple logistic regression model, adjusted for age and sex, and presented as odds ratios (OR). A principal component analysis (PCA), including the statistical significant factors, was also performed to identify thematic, uncorrelated components associated with falls. RESULTS: The use of neuroleptics (OR 3.30, 95% CI: 1.15-9.43), heart failure with symptoms (OR 1.88, 95% CI: 1.17-3.04) and low walking speed (OR 1.77, 95% CI: 1.28-2.46) were prominent individual risk factors for falls. In the PCA, three main components predicting falls were identified: reduced mobility, OR 2.12 (95% CI 1.54-2.91), heart dysfunction, OR 1.66 (95% CI 1.26-2.20) and functional impairment including nocturia, OR 1.38 (95% CI 1.01-1.88). CONCLUSIONS: Three main components predicting falls were identified in a general elderly population after three and six years: reduced mobility, heart dysfunction and functional impairment including nocturia. The use of neuroleptic drugs was also a prominent individual risk factor, although the prevalence was low. Heart failure with symptoms was a significant risk factor for falls and may be of clinical importance as the prevalence of this condition in the elderly is increasing worldwide. There is need for further research on the relation between heart failure and falls in the elderly, as the treatment for this condition is poorly documented in this demographic. The findings of this study may be valuable in the development of intervention programmes aimed at sustainable, long-term reduction of falls in the elderly.